Organization Membership Application

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Representative Senator First Name: Last Name: Job Title: Department: Email: Phone: Primary Bioscience Category Ag/Food/Industrial - Bio-renewables & Bio-energy Ag/Food/Industrial - Food/Nutrition/Alternative Medicine Ag/Food/Industrial - Industrial Chemicals Bio Distribution - Ag, Farm Supplies & Wholesale Bio Distribution - Drugs, Druggists', Sundries, & Wholesale Bio Distribution - Medical, Dental, Hospital supply & Wholesale Information Technology - Data Management Information Technology - Healthcare IT & Digital Health Information Technology - Research Informatics Medical Devices - Dental Equipment & Supplies Medical Devices - Device Contract Manufacturing Medical Devices - Hospital Furnishings & Supplies Medical Devices - Imaging/Radiology Medical Devices - Laboratory Equipment Medical Devices - Medical/Clinical Instruments Medical Devices - Optical/Ophthalmic Medical Devices - Prosthetic/Orthotic Manufacturing Medical Devices - Surgical, Orthopedics & Implantable Pharma & Therapeutics - Animal Health/Veterinary Pharma & Therapeutics - Diagnostic & Research Products Pharma & Therapeutics - Pharma Contract Manufacturing Pharma & Therapeutics - Regenerative Medicine Pharma & Therapeutics - Rx & Consumer Health R&D/Testing Labs - Biotechnology/Pharma (except Nanobiotechnology) R&D/Testing Labs - Cannabis R&D/Testing Labs - Contract Clinical Development R&D/Testing Labs - Contract Pre-Clinical Research R&D/Testing Labs - Contract Product Design/Development R&D/Testing Labs - Diagnostic/Imaging Centers R&D/Testing Labs - Laboratory (Analytical, Industrial, Environment) R&D/Testing Labs - Medical Clinical Laboratories R&D/Testing Labs - Orthotics/Prosthetics Fitting R&D/Testing Labs - Physical, Engineering, and Life Sciences (except Nanotechnology and Biotechnology) Secondary Bioscience Category NAICS Code GMP Compliant Yes No FDA Registered Yes No ISO Certified Government/Nonprofit Categories Business Accelerator/Incubator/Small Business Assistance/SmartZone Economic Development/Government Educational/Community/Private Foundation Industry/Trade Association Patient/Disease/Professional Association Other Educational Clinic Categories Academic Research/Education (University, 4-year College, Institute) Community College/Vocational High School Hospital/Clinical Research Medical Education (Non-Academic) Science Education & Professional Development/Training Technology Transfer/Industry Engagement Service/Vendor Categories Architects Business Development/Strategy Planning Communications/Marketing/PR Economic Development/Government/Legislative Affairs Employee Benefits Engineering Services Facilities Management Financial Services & Consulting Financial Services - Accountants|Banks|etc. Government/Legislative Affairs HR/Staffing/Payroll Information Services Provider Information Technology & Services Insurance/Employee Benefits Investors - VC/Angels Lab & Equipment Support Services Legal/Intellectual Property Manufacturing Support Media/Press Office Equipment/Furniture Other Procurement Services Project Management Prototype/Testing Services Public Relations Real Estate Records Management Regulatory/Reimbursement Safety/Hazardous Materials Software Supplier Technical Writing Manufacturers/Suppliers Categories Adhesives & Seals Automation & Electronics Cabinetry Cables & Cords Casting/Extrusions Chemicals Coating/Plating/Painting Computers/Accessories Contract Manufacturing Assembly Custom Manufacturing Fabrication Distributor - Electric/General Electrical & Power Generation Engineering Services Environmental Structures Filter Media Hardware Fasteners & Springs Instruments & Controls Lubricants Machined Parts Machinery Tools & Supplies Material Handling MEMS Metal Components Optics Other Packaging Plant & Facility Equipment Plastics & Rubber Printed Circuit Boards/Assembly Printed Materials Process Equipment Prototypes Pumps/Valves & Accessories Raw Materials/Bar Stocks/Resins Sensors Stamped Sterile Packaging Tooling/Tool & Die/Fixtures Tubing Captcha